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Please fill out the form on your screen, print out and mail to the address listed below. The Credit Union requires an INK Signature for this application. We will not accept a faxed copy. This helps reduce account fraud.

Baltimore County Employees Federal Credit Union
23 W. Susquehanna Avenue
Towson, Maryland 21204

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I hereby request that you close the following account I maintain with you:
Bank Name:
Member Account Number:
Primary Name on Account:
Secondary Name on Account:
Please send a check for all funds remaining in the account to my attention at:
Name:
Mailing Address:
Second Address Line:
City:
State:	Maryland Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip Code:
Home Phone Number:Home Phone 2Home Phone 3	- -
Daytime Phone Number:Daytime Phone 2Daytime Phone 3Daytime Phone Extension	- - X
X _______________________________________________________ ____________________________ Member's Signature Date

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Baltimore County Employees Federal Credit Union 23 W. Susquehanna Ave., Towson, MD 21204 410-828-4730 ABA/Routing Number: 2520-7575-7